Mea one ofsles is the most highly infectious diseases. Babies under 1 year of age are most at risk of getting measles, but it can affect anyone of any age who has not been vaccinated against the disease or who has not had measles previously.

Although measles is often wrongly dismissed as a minor disease that all children will catch and recover from easily, the effects of measles can be extremely serious and even sometimes fatal.

Thanks to the childhood immunisation programme, the disease in now rare in the UK, although it has not been eliminated all together. If a child is not vaccinated as a baby, he or she will always remain at risk of catching the disease.

Measles is more common abroad. In countries with poor vaccination programmes, measles is a very severe disease. One million children die from measles world-wide each year. Consequently, anyone travelling to countries where measles is a problem must ensure that they and their family are fully immunised.

Causes

Measles is caused by a virus, known as a morbillivirus of the paramyxovirus family. The measles virus is highly infectious and can spread quickly, particularly in close-confined communities such as crèches and play groups if babies and infants are not immunised. The measles virus is spread through airborne transmission of droplets when someone infected with the virus coughs or sneezes without covering their mouth or nose. A person with measles is infectious from about 4 days before to 4 days after a rash appears, but is most infectious before the rash is visible. Consequently, someone can spread the disease before they realise they have measles.

Anyone that has not been immunised against measles or who has not had measles previously is at risk of catching measles if they have been in contact with someone that has measles. Babies under one year are particularly vulnerable as too are children who are malnourished, have vitamin A deficiency, whose immune system is not functioning properly, or who have chronic conditions such as cystic fibrosis, congenital heart or kidney disease and Down’s syndrome.

Symptoms

The incubation period for measles, ie the time taken for symptoms to appear after someone first becomes infected, is about 10 days. The symptoms of measles start like a bad cold with a high temperature, cough, sore eyes and runny nose. A red, blotchy rash appears at the head and spreads to the body and limbs over 3 to 4 days. The rash lasts for about a week before fading. Small red spots with blue-white centres, called Koplik spots, may be seen in the mouth on the inside of the cheeks.

The most common complications of measles are ear infections (otitis media), croup, pneumonia, diarrhoea and eye infections, mostly caused by secondary bacterial infections.

Other rarer, but more serious infections involve the nervous system. Encephalitis (inflammation of the brain) occurs in about 1 in 1,000 cases of measles and can leave children permanently brain damaged. Subacute sclerosing pan-encephalomyelitis (SSPE), a slowly progressive brain infection, is the most severe complication of measles. SSPE usually occurs years after the initial illness, it starts with intellectual impairment, leads to seizures and eventually death. Thankfully, vaccination has caused almost the total disappearance of SSPE in the UK, but it remains a risk if children are not immunised.

The risk of death with measles is age-related. It is highest in children under 1 year, falls in children aged 1 to 9 years and rises again in teenagers and adults.

Measles infection during pregnancy may cause miscarriage or premature labour. If the mother is immune, either through previous vaccination or through previous measles infection, she will not catch measles and so there is no risk to the unborn baby.

Treatment

Measles can be prevented by a highly effective and safe vaccine. In the UK, most children are routinely vaccinated against measles with a vaccine known as MMR, which also protects against mumps and rubella. In 1987, the year before the MMR vaccine was introduced in the UK, 86,000 children caught measles and 16 died. Through the success of the MMR vaccine, no child has died from acute measles in the UK since 1992.

Babies are given the MMR vaccine between 12 and 15 months of age and then given a booster between 4 and 5 years. Infants from 6 months of age travelling to countries where measles is still a problem should also be vaccinated with MMR. As the vaccine is less effective when given early, these infants will need two further doses of the vaccine at the recommended ages to ensure that they are adequately protected.

It is common for children to develop a mild fever and rash after the immunisation and generally feel a bit grizzly. The recommended dose of paracetamol is advised if the child develops a temperature.

When to see your Pharmacist

You can obtain paracetamol from your local pharmacy without the need for a prescription to help reduce your baby’s temperature following immunisation. Always check the label of medicines to make sure that you are not giving your child too much paracetamol if giving more than one product. Aspirin should not be used in babies or in children under 16 years of age to lower high temperatures or for pain relief.

If travelling abroad and you are concerned about the risks of measles, talk to your pharmacist. Your pharmacist has access to regularly updated information about countries where measles remains a problem and if vaccination is required.

When to see your doctor

After MMR vaccination, your baby may be grizzly but if crying is prolonged or there is a persistent rash or fever, you should see your doctor. Swelling might occur at the injection site but is not normally any larger than the size of a 10p coin. Any larger swelling should be checked by your doctor.

If you think you or your baby has the symptoms of measles you should see your doctor immediately, especially if you have recently returned from a country, or been in contact with someone from a country, where measles is still a problem.

If you are sure that your child has measles, notify your doctor so that cases may be reported to the local health authority to allow official figures about the disease to be recorded and coordinated.

Protecting your baby, your family and others against measles

The most effective way of protecting your baby and others against measles is to have your child vaccinated with the MMR vaccine. The childhood immunisation programme provides direct protection against mumps, measles, rubella, diphtheria, whopping cough and the risks of bacterial meningitis caused by pneumococcal bacteria, meningococcal type C and Hib. By providing immunity against mumps and measles, the immunisation programme also helps provide protection against viral meningitis. The risks of all of the diseases covered by the immunisation programme are far, far greater than any risks associated with the vaccines themselves. It is essential that all children are vaccinated at the appropriate times. Vaccination of children also helps reduce the spread of infection to adults.

Safety of MMR vaccine

Since 1998 there has been much publicity in the media wrongly linking the MMR vaccine with autism and bowel disease. This publicity led to many parents delaying their baby’s MMR vaccination or not giving the vaccine at all. Take up of the measles vaccine fell, plummeting to a low of just 80% in 2004; a level at which there is no ‘herd-immunity’, allowing the disease to spread rapidly. As a result, there has been an increase in outbreaks of measles and, tragically, some children and adults have died or been seriously brain damaged.

The reports linking MMR vaccine with autism have since been discredited. The conclusion of experts from all over the world, including the World Health Organization, is that there is no link between MMR vaccines and autism or bowel disease. The World Health Organization advises that the MMR has an exemplary safety record and anticipates that its widespread use will eventually see the eradication of measles, mumps and rubella world-wide. The World Health Organization also advises against using separate vaccines for the simple reason that doing so would leave children at risk and offer no benefits. No country in the world recommends giving MMR as three separate vaccines. Giving the vaccines separately may be harmful because it leaves children open to the risk of catching measles, mumps or rubella. By having them all at once, a child is protected against all three diseases soon after the MMR injection is given.

Consequently, parents are encouraged to have their babies vaccinated against all three diseases with the MMR vaccine at the appropriate time. Parents who decided not to vaccinate their babies are strongly advised to reconsider having their child vaccinated at the earliest opportunity.

Living with measles

A baby or infant should be kept from crèches or play groups for 5 days after the rash appears. The practice of holding ‘measles parties’, deliberately to infect other babies to build their immunity without vaccination, is positively discouraged by the health authorities as it can pose a serious health risk to babies and other children.

To reduce the spread of the virus, encourage all members of the family to use disposable tissues when sneezing or coughing, and to wash their hands regularly throughout the day, not just after going to the toilet.

To ease symptoms, make sure that your baby has plenty of water to drink. A cold flannel applied to the forehead will help reduce a high temperature. Let your baby sleep to help the body recover.

Useful Tips

If your baby develops a fever after immunisation for MMR, sponging with cool water can help get the temperature down